Required Reports

ARKANSAS INSURANCE DEPARTMENT LEGAL DIVISION 1200 West Third Street Little Rock, AR 72201-1904 501-371-2820 FAX 501-371-2629 Bulletin 1-98 March 2, 1998 REQUIRED REPORTS The purpose of this Bulletin is to call attention of Health Maintenance Organizations (HMO’s) to certain required reports that are to be submitted to this Department. For HMO’s offering Point-of-Service contracts, a report is required to be filed on a quarterly and annual basis providing the information required in Exhibit A of the Commissioner’s Guidelines of 1994. This authorized by Ark. Code Ann. §23-76-109(a)(6)(C). All HMO’s are required to file with the Commissioner and Director of the Department of Health an annual report of complaints handled through the complaint system and a report of malpractice claims settled during the year. This is required by Ark. Code. Ann. §23-76-116(a)(2)(A)-(C). Samples of suggested report forms are enclosed. These reports for 1997 were due March 1, 1998 and should have been submitted with the Annual Statement. However, the report may be submitted separately by mailing to the Life and Health Division, Arkansas Insurance Department, 1200 West Third Street, Little Rock, Arkansas 72201-1904. Please note Arkansas Insurance Department Regulation 44 which requires a Complaint Register. The two (2) reports required above are separate from the Regulation 44 Register. The Register is not submitted to the Commissioner but maintained by the HMO and is subject to inspection by the Commissioner. Copies of the aforementioned laws may be obtained from the Arkansas Secretary of State’s Office. Please do not call this office to obtain copies of these laws. Mike Pickens INSURANCE COMMISSIONER om the Regulation 44 Register. The Register is not submitted to the Commissioner but maintained by the HMO and is subject to inspection by the Commissioner. Copies of the aforementioned laws may be obtained from the Arkansas Secretary of State’s Office. Please do not call this office to obtain copies of these laws. Mike Pickens INSURANCE COMMISSIONER ARKANSAS POINT OF SERVICE UTILIZATION ANALYSIS FOR QUARTERS PHYSICAL REFERRAL AND HOSPITALIZATION COST ONLY JANUARY -- MARCH APRIL- - JUNE TOTAL JANUARY -- JUNE In-Network Out- Network Total In- Network Out- Network Total In- Network Out- Network Total Little Rock Fort Smith Percentage of In-Network Utilization Year to Date Percentage of Out-Network Utilization NUMBER OF ENROLLEES COVERED BY POINT OF SERVICE NUMBER OF GROUPS COVERED BY POINT OF SERVICE SIZE OF GROUPS COVERED BY POINT OF SERVICE—LARGEST SIZE OF GROUPS COVERED BY POINT OF SERVICE—SMALLEST PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—1ST QUARTER PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—2ND QUARTER 2 ARKANSAS POINT OF SERVICE UTILIZATION ANALYSIS FOR QUARTERS (POS GROUPS ONLY) PHYSICAL REFERRAL AND HOSPITALIZATION COST ONLY JANUARY --MARCH APRIL- JUNE TOTAL JANUARY --JUNE In-Network Out- Network Total In- Network Out- Network Total In- Network Out- Network Total Little Rock Fort Smith Percentage of In-Network Utilization Year to Date Percentage of Out-Network Utilization NUMBER OF ENROLLEES COVERED BY POINT OF SERVICE NUMBER OF GROUPS COVERED BY POINT OF SERVICE SIZE OF GROUPS COVERED BY POINT OF SERVICE—LARGEST SIZE OF GROUPS COVERED BY POINT OF SERVICE—SMALLEST PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—1ST QUARTER PREMIUMS RECEIVE Percentage of In-Network Utilization Year to Date Percentage of Out-Network Utilization NUMBER OF ENROLLEES COVERED BY POINT OF SERVICE NUMBER OF GROUPS COVERED BY POINT OF SERVICE SIZE OF GROUPS COVERED BY POINT OF SERVICE—LARGEST SIZE OF GROUPS COVERED BY POINT OF SERVICE—SMALLEST PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—1ST QUARTER PREMIUMS RECEIVED FOR POINT OF SERVICE GROUPS—2ND QUARTER 3 HEALTH MAINENANCE ORGANIZATIONS ARKANSAS ANNUAL MALPRACTICE CLAIMS REPORT YEAR ________________ Enrollee Name Date Received Claimed Malpractice Resolution Date Resolved This report is to be filed for each calendar year with the Arkansas Department of Health and the Arkansas Insurance Department by March 1 of each year. Required by Arkansas A.C.A. 23-76-116(a)(2)(C). HMO 3 4